|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$1,684.94 |
| Rate for Payer: Aetna American Axle |
$187.85
|
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.85
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.94
|
| Rate for Payer: BCN Commercial |
$1,684.94
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Advantage |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: Priority Health SBD |
$182.07
|
| Rate for Payer: UMR Bronson Commercial |
$106.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna American Axle |
$187.85
|
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.85
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Advantage |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: Priority Health SBD |
$182.07
|
| Rate for Payer: UMR Bronson Commercial |
$127.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$90.44
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.19
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: BCN Medicare Advantage |
$67.49
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$90.44
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.86
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.24
|
| Rate for Payer: Nomi Health Commercial |
$80.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$67.49
|
| Rate for Payer: PHP Commercial |
$94.49
|
| Rate for Payer: PHP Medicare Advantage |
$67.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111.67
|
| Rate for Payer: Priority Health Medicare |
$67.49
|
| Rate for Payer: Priority Health SBD |
$111.67
|
| Rate for Payer: Priority Health Tiered Network |
$111.67
|
| Rate for Payer: Railroad Medicare Medicare |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.74
|
| Rate for Payer: UHC Core |
$147.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.49
|
| Rate for Payer: UHC Exchange |
$147.74
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$90.44
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.19
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: BCN Medicare Advantage |
$67.49
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$90.44
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.86
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.24
|
| Rate for Payer: Nomi Health Commercial |
$80.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$67.49
|
| Rate for Payer: PHP Commercial |
$94.49
|
| Rate for Payer: PHP Medicare Advantage |
$67.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111.67
|
| Rate for Payer: Priority Health Medicare |
$67.49
|
| Rate for Payer: Priority Health SBD |
$111.67
|
| Rate for Payer: Priority Health Tiered Network |
$111.67
|
| Rate for Payer: Railroad Medicare Medicare |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.74
|
| Rate for Payer: UHC Core |
$147.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.49
|
| Rate for Payer: UHC Exchange |
$147.74
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$426.75 |
| Rate for Payer: Aetna Commercial |
$224.52
|
| Rate for Payer: Aetna Medicare |
$174.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.27
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCBS MAPPO |
$167.55
|
| Rate for Payer: BCN Commercial |
$300.78
|
| Rate for Payer: BCN Medicare Advantage |
$167.55
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cofinity Commercial |
$224.52
|
| Rate for Payer: Cofinity Commercial |
$241.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.93
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.31
|
| Rate for Payer: Nomi Health Commercial |
$201.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.75
|
| Rate for Payer: PACE SWMI |
$167.55
|
| Rate for Payer: PHP Commercial |
$234.57
|
| Rate for Payer: PHP Medicare Advantage |
$167.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$275.29
|
| Rate for Payer: Priority Health Medicare |
$167.55
|
| Rate for Payer: Priority Health SBD |
$275.29
|
| Rate for Payer: Priority Health Tiered Network |
$275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$167.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.69
|
| Rate for Payer: UHC Core |
$351.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.55
|
| Rate for Payer: UHC Exchange |
$351.69
|
| Rate for Payer: UHC Medicaid |
$109.27
|
| Rate for Payer: UHCCP Medicaid |
$109.27
|
| Rate for Payer: UMR Bronson Commercial |
$261.74
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Advantage |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$301.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Advantage |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$253.82
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$212.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.64
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS MAPPO |
$204.61
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$204.61
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$274.18
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.84
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.07
|
| Rate for Payer: Nomi Health Commercial |
$245.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE SWMI |
$204.61
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: PHP Medicare Advantage |
$204.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$337.27
|
| Rate for Payer: Priority Health Medicare |
$204.61
|
| Rate for Payer: Priority Health SBD |
$337.27
|
| Rate for Payer: Priority Health Tiered Network |
$337.27
|
| Rate for Payer: Railroad Medicare Medicare |
$204.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.00
|
| Rate for Payer: UHC Core |
$431.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$204.61
|
| Rate for Payer: UHC Exchange |
$431.00
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
| Rate for Payer: UMR Bronson Commercial |
$315.56
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$212.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.64
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS MAPPO |
$204.61
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$204.61
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$274.18
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.84
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.07
|
| Rate for Payer: Nomi Health Commercial |
$245.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE SWMI |
$204.61
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: PHP Medicare Advantage |
$204.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$337.27
|
| Rate for Payer: Priority Health Medicare |
$204.61
|
| Rate for Payer: Priority Health SBD |
$337.27
|
| Rate for Payer: Priority Health Tiered Network |
$337.27
|
| Rate for Payer: Railroad Medicare Medicare |
$204.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.00
|
| Rate for Payer: UHC Core |
$431.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$204.61
|
| Rate for Payer: UHC Exchange |
$431.00
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
| Rate for Payer: UMR Bronson Commercial |
$315.56
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare |
$61.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.75
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.55
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$59.55
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.53
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.50
|
| Rate for Payer: Nomi Health Commercial |
$71.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$59.55
|
| Rate for Payer: PHP Commercial |
$83.37
|
| Rate for Payer: PHP Medicare Advantage |
$59.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.54
|
| Rate for Payer: Priority Health Medicare |
$59.55
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: Priority Health Tiered Network |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$59.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.55
|
| Rate for Payer: UHC Exchange |
$128.24
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$79.55 |
| Max. Negotiated Rate |
$526.62 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS Trust/PPO |
$526.62
|
| Rate for Payer: BCN Commercial |
$526.62
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Advantage |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: UMR Bronson Commercial |
$79.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare |
$61.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.75
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.55
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$59.55
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$85.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.53
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.50
|
| Rate for Payer: Nomi Health Commercial |
$71.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$59.55
|
| Rate for Payer: PHP Commercial |
$83.37
|
| Rate for Payer: PHP Medicare Advantage |
$59.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.54
|
| Rate for Payer: Priority Health Medicare |
$59.55
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: Priority Health Tiered Network |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$59.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.55
|
| Rate for Payer: UHC Exchange |
$128.24
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Advantage |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: UMR Bronson Commercial |
$94.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Aetna Commercial |
$151.45
|
| Rate for Payer: Aetna Medicare |
$117.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.75
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCBS MAPPO |
$113.02
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: BCN Medicare Advantage |
$113.02
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$151.45
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.67
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.32
|
| Rate for Payer: Nomi Health Commercial |
$135.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.25
|
| Rate for Payer: PACE SWMI |
$113.02
|
| Rate for Payer: PHP Commercial |
$158.23
|
| Rate for Payer: PHP Medicare Advantage |
$113.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$186.87
|
| Rate for Payer: Priority Health Medicare |
$113.02
|
| Rate for Payer: Priority Health SBD |
$186.87
|
| Rate for Payer: Priority Health Tiered Network |
$186.87
|
| Rate for Payer: Railroad Medicare Medicare |
$113.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.48
|
| Rate for Payer: UHC Core |
$245.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$113.02
|
| Rate for Payer: UHC Exchange |
$245.48
|
| Rate for Payer: UHC Medicaid |
$72.42
|
| Rate for Payer: UHCCP Medicaid |
$72.42
|
| Rate for Payer: UMR Bronson Commercial |
$224.02
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$561.04 |
| Max. Negotiated Rate |
$3,262.50 |
| Rate for Payer: Aetna Commercial |
$1,193.14
|
| Rate for Payer: Aetna Medicare |
$926.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.18
|
| Rate for Payer: BCBS Complete |
$589.09
|
| Rate for Payer: BCBS MAPPO |
$890.40
|
| Rate for Payer: BCN Commercial |
$1,413.27
|
| Rate for Payer: BCN Medicare Advantage |
$890.40
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,193.14
|
| Rate for Payer: Cofinity Commercial |
$1,282.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.92
|
| Rate for Payer: Meridian Medicaid |
$589.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$979.44
|
| Rate for Payer: Nomi Health Commercial |
$1,068.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,262.50
|
| Rate for Payer: PACE SWMI |
$890.40
|
| Rate for Payer: PHP Commercial |
$1,246.56
|
| Rate for Payer: PHP Medicare Advantage |
$890.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,519.79
|
| Rate for Payer: Priority Health Medicare |
$890.40
|
| Rate for Payer: Priority Health SBD |
$1,519.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,519.79
|
| Rate for Payer: Railroad Medicare Medicare |
$890.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,732.50
|
| Rate for Payer: UHC Core |
$1,732.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$890.40
|
| Rate for Payer: UHC Exchange |
$1,732.50
|
| Rate for Payer: UHC Medicaid |
$561.04
|
| Rate for Payer: UHCCP Medicaid |
$561.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,001.00
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$568.28 |
| Max. Negotiated Rate |
$1,687.28 |
| Rate for Payer: Aetna Commercial |
$1,169.89
|
| Rate for Payer: Aetna Medicare |
$907.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.19
|
| Rate for Payer: BCBS Complete |
$596.69
|
| Rate for Payer: BCBS MAPPO |
$873.05
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$873.05
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,169.89
|
| Rate for Payer: Cofinity Commercial |
$1,257.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$916.70
|
| Rate for Payer: Meridian Medicaid |
$596.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$960.36
|
| Rate for Payer: Nomi Health Commercial |
$1,047.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,507.50
|
| Rate for Payer: PACE SWMI |
$873.05
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: PHP Medicare Advantage |
$873.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,565.57
|
| Rate for Payer: Priority Health Medicare |
$873.05
|
| Rate for Payer: Priority Health SBD |
$1,565.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,565.57
|
| Rate for Payer: Railroad Medicare Medicare |
$873.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,687.28
|
| Rate for Payer: UHC Core |
$1,687.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$873.05
|
| Rate for Payer: UHC Exchange |
$1,687.28
|
| Rate for Payer: UHC Medicaid |
$568.28
|
| Rate for Payer: UHCCP Medicaid |
$568.28
|
| Rate for Payer: UMR Bronson Commercial |
$924.60
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$366.15 |
| Max. Negotiated Rate |
$1,675.50 |
| Rate for Payer: Aetna Commercial |
$749.89
|
| Rate for Payer: Aetna Medicare |
$582.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.85
|
| Rate for Payer: BCBS Complete |
$384.46
|
| Rate for Payer: BCBS MAPPO |
$559.62
|
| Rate for Payer: BCN Commercial |
$929.73
|
| Rate for Payer: BCN Medicare Advantage |
$559.62
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cofinity Commercial |
$749.89
|
| Rate for Payer: Cofinity Commercial |
$805.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.60
|
| Rate for Payer: Meridian Medicaid |
$384.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$615.58
|
| Rate for Payer: Nomi Health Commercial |
$671.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,675.50
|
| Rate for Payer: PACE SWMI |
$559.62
|
| Rate for Payer: PHP Commercial |
$783.47
|
| Rate for Payer: PHP Medicare Advantage |
$559.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$993.86
|
| Rate for Payer: Priority Health Medicare |
$559.62
|
| Rate for Payer: Priority Health SBD |
$993.86
|
| Rate for Payer: Priority Health Tiered Network |
$993.86
|
| Rate for Payer: Railroad Medicare Medicare |
$559.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.82
|
| Rate for Payer: UHC Core |
$1,044.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$559.62
|
| Rate for Payer: UHC Exchange |
$1,044.82
|
| Rate for Payer: UHC Medicaid |
$366.15
|
| Rate for Payer: UHCCP Medicaid |
$366.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,027.64
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$506.88
|
| Rate for Payer: Aetna Medicare |
$393.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.71
|
| Rate for Payer: BCBS Complete |
$262.56
|
| Rate for Payer: BCBS MAPPO |
$378.27
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: BCN Medicare Advantage |
$378.27
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$506.88
|
| Rate for Payer: Cofinity Commercial |
$544.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.18
|
| Rate for Payer: Meridian Medicaid |
$262.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$416.10
|
| Rate for Payer: Nomi Health Commercial |
$453.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.00
|
| Rate for Payer: PACE SWMI |
$378.27
|
| Rate for Payer: PHP Commercial |
$529.58
|
| Rate for Payer: PHP Medicare Advantage |
$378.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$792.72
|
| Rate for Payer: Priority Health Medicare |
$378.27
|
| Rate for Payer: Priority Health SBD |
$792.72
|
| Rate for Payer: Priority Health Tiered Network |
$792.72
|
| Rate for Payer: Railroad Medicare Medicare |
$378.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.12
|
| Rate for Payer: UHC Core |
$777.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$378.27
|
| Rate for Payer: UHC Exchange |
$777.12
|
| Rate for Payer: UHC Medicaid |
$250.06
|
| Rate for Payer: UHCCP Medicaid |
$250.06
|
| Rate for Payer: UMR Bronson Commercial |
$592.48
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$459.65 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Aetna Commercial |
$955.97
|
| Rate for Payer: Aetna Medicare |
$741.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.97
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS MAPPO |
$713.41
|
| Rate for Payer: BCN Commercial |
$1,217.06
|
| Rate for Payer: BCN Medicare Advantage |
$713.41
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.31
|
| Rate for Payer: Cofinity Commercial |
$955.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$713.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.08
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$784.75
|
| Rate for Payer: Nomi Health Commercial |
$856.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,593.75
|
| Rate for Payer: PACE SWMI |
$713.41
|
| Rate for Payer: PHP Commercial |
$998.77
|
| Rate for Payer: PHP Medicare Advantage |
$713.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,232.63
|
| Rate for Payer: Priority Health Medicare |
$713.41
|
| Rate for Payer: Priority Health SBD |
$1,232.63
|
| Rate for Payer: Priority Health Tiered Network |
$1,232.63
|
| Rate for Payer: Railroad Medicare Medicare |
$713.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,430.87
|
| Rate for Payer: UHC Core |
$1,430.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$713.41
|
| Rate for Payer: UHC Exchange |
$1,430.87
|
| Rate for Payer: UHC Medicaid |
$459.65
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
| Rate for Payer: UMR Bronson Commercial |
$977.50
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$291.17 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$599.61
|
| Rate for Payer: Aetna Medicare |
$465.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.36
|
| Rate for Payer: BCBS Complete |
$305.73
|
| Rate for Payer: BCBS MAPPO |
$447.47
|
| Rate for Payer: BCN Commercial |
$761.91
|
| Rate for Payer: BCN Medicare Advantage |
$447.47
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$599.61
|
| Rate for Payer: Cofinity Commercial |
$644.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.84
|
| Rate for Payer: Meridian Medicaid |
$305.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.22
|
| Rate for Payer: Nomi Health Commercial |
$536.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$447.47
|
| Rate for Payer: PHP Commercial |
$626.46
|
| Rate for Payer: PHP Medicare Advantage |
$447.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$771.65
|
| Rate for Payer: Priority Health Medicare |
$447.47
|
| Rate for Payer: Priority Health SBD |
$771.65
|
| Rate for Payer: Priority Health Tiered Network |
$771.65
|
| Rate for Payer: Railroad Medicare Medicare |
$447.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.57
|
| Rate for Payer: UHC Core |
$871.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.47
|
| Rate for Payer: UHC Exchange |
$871.57
|
| Rate for Payer: UHC Medicaid |
$291.17
|
| Rate for Payer: UHCCP Medicaid |
$291.17
|
| Rate for Payer: UMR Bronson Commercial |
$724.96
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$544.81 |
| Rate for Payer: Aetna Commercial |
$354.03
|
| Rate for Payer: Aetna Medicare |
$274.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.45
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS MAPPO |
$264.20
|
| Rate for Payer: BCN Commercial |
$465.12
|
| Rate for Payer: BCN Medicare Advantage |
$264.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$354.03
|
| Rate for Payer: Cofinity Commercial |
$380.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$277.41
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$290.62
|
| Rate for Payer: Nomi Health Commercial |
$317.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.50
|
| Rate for Payer: PACE SWMI |
$264.20
|
| Rate for Payer: PHP Commercial |
$369.88
|
| Rate for Payer: PHP Medicare Advantage |
$264.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$544.81
|
| Rate for Payer: Priority Health Medicare |
$264.20
|
| Rate for Payer: Priority Health SBD |
$544.81
|
| Rate for Payer: Priority Health Tiered Network |
$544.81
|
| Rate for Payer: Railroad Medicare Medicare |
$264.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.29
|
| Rate for Payer: UHC Core |
$523.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$264.20
|
| Rate for Payer: UHC Exchange |
$523.29
|
| Rate for Payer: UHC Medicaid |
$176.36
|
| Rate for Payer: UHCCP Medicaid |
$176.36
|
| Rate for Payer: UMR Bronson Commercial |
$319.24
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$721.12
|
| Rate for Payer: Aetna Medicare |
$559.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.94
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$538.15
|
| Rate for Payer: BCN Commercial |
$860.51
|
| Rate for Payer: BCN Medicare Advantage |
$538.15
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$721.12
|
| Rate for Payer: Cofinity Commercial |
$774.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.06
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.97
|
| Rate for Payer: Nomi Health Commercial |
$645.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$538.15
|
| Rate for Payer: PHP Commercial |
$753.41
|
| Rate for Payer: PHP Medicare Advantage |
$538.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$919.87
|
| Rate for Payer: Priority Health Medicare |
$538.15
|
| Rate for Payer: Priority Health SBD |
$919.87
|
| Rate for Payer: Priority Health Tiered Network |
$919.87
|
| Rate for Payer: Railroad Medicare Medicare |
$538.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.07
|
| Rate for Payer: UHC Core |
$927.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.15
|
| Rate for Payer: UHC Exchange |
$927.07
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
| Rate for Payer: UMR Bronson Commercial |
$657.80
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$457.95 |
| Max. Negotiated Rate |
$1,381.50 |
| Rate for Payer: Aetna Commercial |
$917.30
|
| Rate for Payer: Aetna Medicare |
$711.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.75
|
| Rate for Payer: BCBS Complete |
$480.85
|
| Rate for Payer: BCBS MAPPO |
$684.55
|
| Rate for Payer: BCN Commercial |
$1,114.98
|
| Rate for Payer: BCN Medicare Advantage |
$684.55
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cofinity Commercial |
$917.30
|
| Rate for Payer: Cofinity Commercial |
$985.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.78
|
| Rate for Payer: Meridian Medicaid |
$480.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$753.00
|
| Rate for Payer: Nomi Health Commercial |
$821.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.50
|
| Rate for Payer: PACE SWMI |
$684.55
|
| Rate for Payer: PHP Commercial |
$958.37
|
| Rate for Payer: PHP Medicare Advantage |
$684.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,191.88
|
| Rate for Payer: Priority Health Medicare |
$684.55
|
| Rate for Payer: Priority Health SBD |
$1,191.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,191.88
|
| Rate for Payer: Railroad Medicare Medicare |
$684.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,231.29
|
| Rate for Payer: UHC Core |
$1,231.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$684.55
|
| Rate for Payer: UHC Exchange |
$1,231.29
|
| Rate for Payer: UHC Medicaid |
$457.95
|
| Rate for Payer: UHCCP Medicaid |
$457.95
|
| Rate for Payer: UMR Bronson Commercial |
$847.32
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$1,011.00 |
| Rate for Payer: Aetna Commercial |
$793.01
|
| Rate for Payer: Aetna Medicare |
$615.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.19
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCBS MAPPO |
$591.80
|
| Rate for Payer: BCN Commercial |
$940.68
|
| Rate for Payer: BCN Medicare Advantage |
$591.80
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$793.01
|
| Rate for Payer: Cofinity Commercial |
$852.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.39
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$650.98
|
| Rate for Payer: Nomi Health Commercial |
$710.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,011.00
|
| Rate for Payer: PACE SWMI |
$591.80
|
| Rate for Payer: PHP Commercial |
$828.52
|
| Rate for Payer: PHP Medicare Advantage |
$591.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,005.57
|
| Rate for Payer: Priority Health Medicare |
$591.80
|
| Rate for Payer: Priority Health SBD |
$1,005.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,005.57
|
| Rate for Payer: Railroad Medicare Medicare |
$591.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.64
|
| Rate for Payer: UHC Core |
$1,006.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$591.80
|
| Rate for Payer: UHC Exchange |
$1,006.64
|
| Rate for Payer: UHC Medicaid |
$400.23
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
| Rate for Payer: UMR Bronson Commercial |
$620.08
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$443.47 |
| Max. Negotiated Rate |
$1,493.25 |
| Rate for Payer: Aetna Commercial |
$887.08
|
| Rate for Payer: Aetna Medicare |
$688.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.28
|
| Rate for Payer: BCBS Complete |
$465.64
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCN Commercial |
$1,076.14
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$887.08
|
| Rate for Payer: Cofinity Commercial |
$953.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$465.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$728.20
|
| Rate for Payer: Nomi Health Commercial |
$794.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,493.25
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Commercial |
$926.80
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,150.36
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health SBD |
$1,150.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,150.36
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.51
|
| Rate for Payer: UHC Core |
$1,175.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$662.00
|
| Rate for Payer: UHC Exchange |
$1,175.51
|
| Rate for Payer: UHC Medicaid |
$443.47
|
| Rate for Payer: UHCCP Medicaid |
$443.47
|
| Rate for Payer: UMR Bronson Commercial |
$915.86
|
|
